They're most obvious with "basic" products like energy and comms - in theory what is delivered is mostly undifferentiated kWh or GB but through the magic of "confusing plans", marketers have succeeded in making comparisons very difficult for regular people.
(You can do it, but you need OCD, a year of billing data and a spreadsheet - which greatly exceeds the cognitive effort most people will invest in choosing a mobile or energy provider).
The US healthcare sector seems to be the largest, most intricate and most successful (in terms of gdp extraction) confusopoly in history.
The USA healthcare price gouges via run away prices. Healthcare corporations corrupting congress is the fuel that forces this on people (and breaks a free market).
That being said, Canada has a huge health care problem right now. Frequently they need to close emergency services in major (& minor) cities at night due to staff shortages. The wait times for basic diagnostics is on the order of months (not days or weeks). For example, a relative of mine has lost 90 pounds since the start of the year, complained of chest pains and couldn’t (still can’t) swallow. They just got a basic scan after 6 months of waiting to confirm a baseball sized tumour in their lungs.
For many years we ran with just the bare minimum of staffing and equipment to keep costs low, and now, due to a number of factors our system can’t keep up.
Waste is not good, but a little bit of extra capacity (and cost) isn’t a bad thing when it comes to emergency services.
We are now reaping what they have sown.
This is a classic "underfund to prove the system doesn't work thus we must privatize it!" move.
Governments of the last 20 years have held the status quo, which leaves them equally culpable.
Second sentence: explain people’s motivations
You don't have to assume. It costs twice as much as the most expensive health systems on earth, but delivers Afghanistan-level life expectancies. The problem isn't that we're spending too little.
Afghanistan is a whole decade off that cohort.
Life expectancy is a particularly bad metric to use to compare health care systems, because it's heavily influenced by (1) how much people drive, (2) how much violent crime there is, and (3) how much drug addiction the country has. None of those are health care metrics.
I don't believe there's any credible critic of American health care that premises their complaint on America delivering bad health care. We deliver pretty excellent health care, and we deliver it faster than a lot of countries with better health care outcomes. We are in many places in the US overprovisioned for care (by measurements like empty hospital beds, or overprescription of elective procedures). The chief complaint about American health care is how expensive it is, not how good it is.
That distinction is especially important because getting costs down may involve confronting the ways American care is better than it needs to be or should be. For instance: we do a lot more elective surgeries than countries with better outcomes, in part because we do them outpatient here, and they're inpatient (a much bigger deal) elsewhere. For example, my understanding is you're much more likely to get a hernia repaired (probably needlessly) here than in the UK.
Ref: https://www.fao-on.org/en/Blog/Publications/interprovincial-...
It's being underfunded by at least 10-15%, which is a lot for a system expected to run as cost effectively as possible. I'm getting that number from the average of $5336 vs ON at $4800. 4800/5336 = ~89%
I don't think we should aspire to US levels of GDP share. That seems quite excessive.
I think the solutions to our issues are structural changes and adequate funding.
The NHS is still wildly popular so it's politically impossible to privatize from the outside in but it's becoming less popular as its effectiveness declines due to expanding mismanagement, underfunding and corruption when awarding contracts.
The frog has to be boiled slowly though.
The crazy thing to me about this is, most Americans simply skip medical procedures, or tests due to cost.
So American wait times aren't lower because their hospitals are better, they just server a much smaller pool of people due to so many being priced out of being healthy.
And honestly, the longer you go without doctor visits, more expensive, complicated and involved the process is.
That is an atrocious number and something that needs fixing but we don’t need to exaggerate it to make that true.
The 1/3rd is people avoiding treatment recommended by a doctor. 43% of people reported to have avoided healthcare due to costs.
To me "Not most people, only 43%" isn't what I would consider too much of an exaggeration.
We don’t know how many people skip healthcare because a doctor is inconvenient (in the states or in other regimes) either. So it seemed the most appropriate comparison to make.
This seems like a completely reasonable approach and I’m always surprised that it’s not the default.
It's also impossible to get a 2nd opinion. The specialists all tend to belong to the same groups so you'll call a different doctor and eventually get shunted back to the exact same doctor you started out with. Where the the competition?
(Ridiculousness not being the pandemic itself, but inadequate resources, planning, and political cover from all levels of government.)
Part of this is COVID burnout. It wasn't this bad in 2019. Wife works in healthcare and sees the difference every day. Nurses crying etc.
For many years Canada (and similar countries) have relied on cutting costs by importing health care professionals from other countries. That pipeline has now shrunk considerably, resulting in the exposure of the underlying problem.
This says 10.2% as of 2020 : https://www.aihw.gov.au/reports/health-welfare-expenditure/h...
Any improvement in efficiency would mean those people lose out on jobs. A new use for them must be found, or there will be massive unemployment (at least, short-medium term).
I mean I don't want anyone suffering either (one would hope you'd have adequate social safety net to take care of these people until they find another job) but it's such a bizarre exemption to carve out
For a theoretical based on what actually happened where I live, Hospital X is contractually obligated to use a specific kind of infusion pump from supplier Y and order blood tests from specific supplier Z in order to get Blue Cross Blue Shield coverage. Meanwhile the state university pushed out the other hospital in the city and heavily expanded the surviving hospital campus they sponsored to take on the increased capacity and introduce the services they were previously lacking compared to their now dead competitor. So Hospital X is just following the policy of University Network A. All of which is a common practice.
In many states the state university sponsored medical care networks are the or are close to being the biggest employers. The University Of Iowa medical network, the West Virginia University network, and University Of Pittsburgh Medical Center network all have taken over a majority of medical care functions in their states, leaving mostly specialists and those in mental health to independent practices. That exacerbates the issue of insurance and supplier contracts, because these small places that are competing with the university networks often don't bother with insurance unless it's government provided and just prefer patients pay up front instead. They lose too much time and money sorting through the myriad private insurance providers, plans, and coverage obligations without full time staff to handle that for them. Medical billing is a massive industry for a reason.
Now, if everyone wasn't chained to private insurance and juggling all of these providers, coverage limits, and contractual obligations the number of inefficiencies and thus the overall cost would decrease. We have historical examples of this even in the U.S., by comparing what happened between 1960 to 1975 and it's modern equivalent of 2005 to 2020. Healthcare costs were increasing rapidly, doctors were dwindling in number, and there weren't enough medical students for generalist fields in the 1960s just like the 2010s. The major difference is that while quality of care continued to increase through the 1960s and early 1970s, both the efficacy and quality of care has gone down since the 2000s. The several minor differences were that nationwide coverage was rarely available in the 1960s compared to the 2010s, that Medicare was spending more than it was receiving in the early 1970s thanks to how Medicare was funded in the 1960s, and that privatization of entire hospitals was uncommon and frowned upon in the 1960s because of the income impact it had on the doctors. The U.S. barely survived the 1960s medical crunch with enough government intervention, but it is dying under the weight of the 2010s medical crunch because the government can't easily intervene and is lobbied to maintain distance.
So the reason the lead figures in the American right are worried about single payer is because they won't make as much money. And they're very good at convincing people to vote against their own interests because they know those people don't care to look into complex systems too deeply. As a result many of the regular voters and workers are worried because someone told them a lie about where the money is actually being wasted and what the actual history is.
Just picking this point out - how can lobbying stop something? As in it's worth too much lobby money to politicians to change it?
For instance, Germany is producing the Leopard 2. They may export most of them during peacetime, but should they need to, they could start pumping out those tanks for the Bundeswehr instead. Furthermore, with the skills available domestically, it would take much less time to repurpose VW/BMW/Audi factories to also produce weapons.
The first economist says to the other “I’ll pay you $100 to eat that pile of shit.” The second economist takes the $100 and eats the pile of shit.
They continue walking until they come across a second pile of shit. The second economist turns to the first and says “I’ll pay you $100 to eat that pile of shit.” The first economist takes the $100 and eats a pile of shit.
Walking a little more, the first economist looks at the second and says, "You know, I gave you $100 to eat shit, then you gave me back the same $100 to eat shit. I can't help but feel like we both just ate shit for nothing."
"That's not true," responded the second economist. "We increased the GDP by $200!"
You used a wrong allegory to try to demonstrate a point that noone was making.
Another example of political economy is two different efforts to address climate crisis, with very different outcomes.
During the Obama Admin, the push was for carbon taxes. Wonks loved it. Logical, concise, moral. Complete nonstarter. Because carbon taxes has no built-in constituency that's willing to advocate and defend it.
Whereas in 2020, progressives pushed "green new deal" themed industrial policy and investment strategy. Made most everyone a benefactor. Millions of jobs. 100s of billions of dollars. Much better political economy.
Thankfully the economist bastiat solved this absurdity in 1850.
https://en.m.wikipedia.org/wiki/Parable_of_the_broken_window
you laugh, but this is exactly what the US gov't does, esp. with military budget allocation. Why do you think all sorts of military products are split into different pieces for manufacturing, separated into different states? It certainly doesn't help efficiency.
I'm not saying that healthcare shouldn't be improved via efficiency increases - it needs improving! But let's not kumbaya and ignore the plight of those whose livelihood would be disrupted (and not of their own fault).
Also a marginal Joule that you can demand at will is different from one that you committed to months in advance.
Similarly for data.
Of course, in practice most plans don't reflect this 'essential' complexity, but are full of accidental complexity to confuse people.
Ted Cruz would probably cosign a bill to 'throw all puppies off a mountain' for an all inclusive trip to Tulum
Academically this sounds enlightening, but it only takes one cursory walk around a supermarket in the US to see this is unequivocally false. Healthcare is an externality, not a base of anything. From the average customer to the product in the aisle to the marketing - everything is 100% not a direct cost benefit function in terms of healthcare.
Where I live in Europe, the expectation is that the kids will walk or take the bike to school. 95% of the paths they need to travel is covered by walkways (usually separated from the roads, and in many cases with dedicated bike lanes). Everywhere the kids need to cross, there are crosswalks, and every morning before school a team of parents is organized to safeguard these crosswalks.
Meanwhile, driving is slowed down significantly by the efforts above. The roads are underfunded and lines tend to form around the school (some parents still do drive their kids, up to about half when the weather is really bad). But with parents blocking the crosswalk every time a kid is near, bottlenecks do form. Basically, if you're in a car, you're treated as a 2nd rate citizen. :)
Oh, and I suppose one benefit of all this walking is that hospital bills go down. Mostly because of the exercise, but also to some extent due reduction in air polution (which is helped further by most of the remaining cars being electric, most of which, ironically, are of a certain American brand).
wow, didn't realize so much of EU can afford electric vehicles. They are more expensive over here in the U.S. - especially compared to a decent used car. Is this a function of the cost of fuel being much higher over there? Or are there subsidies for purchasing electric or something else?
I don't live in the EU, though. You need to move a bit further north and west.
And it's not that electric cars are cheaper here than in the US, rather other cars are taxed at +100% or so (more for "luxery" cars), while electric cars have had low to zero taxes.
Also, fuel has an extra tax of about $1/liter ($3.8/gallon) on top of the normal price (and 25% VAT even on that), meaning even before the current boom, fuel was typically priced around $1.5-$/l (around $5-$7/gallon), and has been approaching $2.5-$3/l (up to about $10/gallon) recently.
Another difference compared to the US is that we have about 25% fewer cars per capita here, despite having about 20% higher nominal GDP per capita than the US (purchasing power of households are lower than in the US, due to taxes and tariffs ). Partly because of car-hostile taxes (except for electric cars) and partly because other means of transportation are subsidized. More of the money is put into buses, trains and sidewalks and less into cars, roads and parking lots.
Unfortunately I think your comment is even less enlightening.
I mean, not all healthcare problems are caused by lifestyle. So clearly healthcare is a base layer - there is no situation where it wouldn’t exist.
So I'll break down my reasoning a bit. It requires a full blog post to get out, so please forgive the abridged version.
Healthcare is a catch all for all the other problems of society. The top costly conditions in the US are (in order of this barely sourced article): Mental Disorders, Heart Conditions, Trauma-Related Injuries, Diabetes, Cancer, COPD and Asthma.
Every single one of these is plainly racking up unneeded costs by the daily actions of all of us. My quip on the supermarket was a remark on the total view of health (from mental to reproductive care to basic carcinogens to ...).
How many people are mindlessly scrolling on Instagram while performing another task, how many people smell of cigarettes, the marketing of 'sinful goods' (depending on the state), the near impossibility to avoid added sugar in every packaged foodstuff, the number of 'alcohol noses' you can see down a 50ft isle, the parenting of children, the smell of fossil fuel exhaust from the parking lot, the gait of the elderly, injured, or soon-to-be, the accommodations (or lack thereof) for those in wheelchairs and with living assistance, and still the primary food at checkout - And to include everyone in the conversation: think of the anyone working two jobs and has 0 time to prepare fresh food for themselves or anyone else, the eventual cost is in the habitual behaviors made in the constraints of under-compensated labor.... I could keep going and I've left out other observations contributing to other conditions but I think you understand.
The thing I'm trying to say is that there are interventions all over the place - however, the up-front costs (ignoring all else) of a 'double blind randomized trial' for every single one of them to earn the proper authority to define its relative utility to cost is unrealistic at the moment (also most governments do not allow for risk based price of care) - an economic externality.
Couple this externality behavior with a market of near perfect inelasticity for good health (and before someone comments, yes, suicide / assisted euthanasia may not be inelastic in price on this metric) - and you can't say "Healthcare is such a base layer of the economy" - an alternative analysis is "Healthcare is an externality that is priced in a government controlled market"
[Edit] I completely left out the externality of the high reward litigation industry on malpractice and all of the above conditions as evidence of harm - adding pressure on compensation to the highest paid professionals.
One of the nice things about working from home is that it allows people to escape that kind of environment to a point, but it just enables other types of obsessive micromanagement like "Why hasn't your mouse moved for 15 minutes!" or keeping cameras pointed at you all day long.
What we really need is less micromanaging and an expectation that not everyone is going to be at their desk every minute of the day, but that's a very hard sell in some environments.
It definitely isn't, standing puts enormous strains on our bodies. Walking for 6h is much easier and better, but sitting out lying down are much better than just standing.
do you have evidence to support these claims? what makes the US patient population or their expectations or the US taxation system unique in the world?
A part of the latter is based on the actual superiority of the quality of medical care in this country -- due to the high levels of wealth produced by this (mostly market-oriented) economy and advanced medical technology, doctors can in fact perform miracles here that they cannot elsewhere.
How is it superior? Sure, some countries fare worse. But folks aren't getting the healthcare they need because of cost, and the results aren't exactly the best in the world. I'm not convinced that "culturally" folks have high expectations either, and sure, you might want to change your lifestyle to lose weight - but at the same time, you might just need medical oversight to do so. Not to mention that a bunch of things medicine helps are not things that lifestyle just fixes.
It sounds like your point is that wider delivery of healthcare would be superior overall. That's fine, but I contend that the best way to achieve that is by increasing the supply of healthcare providers, instead of applying a price ceiling, which leads to shortages (as seen elsewhere on this thread[0]) and quality deterioration.
This is a big thing. I'm in the UK, where healthcare is very socialised, but I very much appreciate the fact that the US invests in making and productionising the next generation of healthcare, which we can then buy in bulk at a discount.
I've been hospitalized in four different countries. The least sane was America. The sanest was a private hospital in England, but the public hospital in England was fine too. My home country of Canada is sane, reliable, and reliably slow and mediocre bordering on subpar. Cyprus lacked toilet seats, but at least the food was fantastic.
America's healthcare system is bananas. Even trying to come up with a metaphor here is difficult. It's $5k a day stays with Wonderbread, tuna, and bad not-actually-mayo-mayo for lunch. It's well groomed, well respected, monied indentured second and third opinion servants. It's Moloch's own mediation on Moloch[0] sold on the discount rack of the bookstore pharmacy downstairs.
You can think Americans are different. They are not. They move to Canada all the time and we service their bum knees just fine.
You can think Americans do all the medical research in the world. They don't. Plenty comes out of Europe, China, and elsewhere.
You can think your tax code is unique. Ok this one I kinda agree with. It's almost as bananas as your medical system. But it doesn't change the fact that Americans put up with absolute bananaspants insanity for a healthcare system when they're perfectly capable of funding their libraries and roads.
China beats you on scale. And so on.
The basic fact is that Americans have what is essentially a psychopathic medical system at the best of times. One can negotiate with a psychopath, but Kafka returns your offer with a can of stale soup and doesn't even laugh.
[0] https://slatestarcodex.com/2014/07/30/meditations-on-moloch/
https://en.wikipedia.org/wiki/List_of_countries_by_research_...
At the end of the day, though, this is a distraction from the core argument. A valid defence of US healthcare policy is not "but we're good at research." Imagine if China was trying to defend their overbudget and under-effective military by talking up how much they've done for global aeronautical research.
Grandma lost her house because she got kidney stones, but, butterfingers, at least we research stuff! Oh and often times our pharma kills more people than it saves and true justice is never metered out ala opioid epidemic.
Keep shouting #1, #1, #1 until you believe it.
If it's that big of a deal for you, work to fix it and you can come on here with your credentials and blah blah instead of whining about people who have experience in what they're talking about :)
Where bankruptcy becomes an issue is when a medical condition leaves someone unable to work for months. With no income they can burn through savings and credit quickly. Then when they file for bankruptcy of course they have some medical debts, but those medical debts are typically not the primary cause of the bankruptcy and even if the medical debts were eliminated they would still be insolvent.
But a medical condition that means you can’t work is the #1 cause of medical bankruptcy in Canada.